Objectives/Purpose:
Head and neck cancers (HNC) affect appearance, identity, and psychological functioning, threatening the sense of self-continuity—the feeling of being the same person over time. Preserving continuity is associated with better outcomes. This study examined how emotional distress and gender influence self-continuity in HNC survivors compared to a matched control group. We hypothesized that HNC would reduce self-continuity through increased emotional distress, particularly in women.
Sample and Setting:
This cross-sectional, questionnaire-based study involved 83 adults (43 HNC patients and 40 matched controls). Due to the exploratory nature, no formal a priori power analysis was conducted, but a target sample size of 40 per group was selected based on recommendations for detecting medium-sized effects in mediation models (Fritz & MacKinnon, 2007; Hayes, 2018). Participants completed validated self-report measures assessing anxiety, depression, and self-continuity.
Procedures:
We used a moderated mediation model (Model 7, PROCESS macro in SPSS) to test whether depression mediated the association between group status (HNC vs. control) and self-continuity, and whether this indirect effect was moderated by gender.
Results:
Contrary to expectations, HNC patients did not report significantly lower self-continuity than controls (t = –0.574, p = .567). However, in the HNC group, both anxiety and depression were significantly associated with lower continuity (r = –.473 and r = –.406; p < .001). Women reported higher distress and lower continuity. Depression mediated the effect of cancer on continuity in men (indirect effect = –0.93, 95% CI \[–1.98; –0.11]) but not in women (–0.32, 95% CI \ [–1.40; 0.46]).
Conclusion and Clinical Implications:
Psychological distress, more than cancer itself, disrupts self-continuity. Gender differences highlight the need for targeted psychosocial interventions supporting emotional resilience and identity reconstruction in HNC survivorship care.